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Digoxin toxicity — SCE Acute Medicine MCQ

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EasyToxicology and OverdoseDigoxin toxicitySCE Acute Medicine

A 82-year-old woman presents with collapse, confusion or vomiting after a possible exposure. Relevant history includes medication, recreational or environmental exposure. On assessment, toxidrome features and physiological instability are present. Investigations show bradyarrhythmia, ectopy, hyperkalaemia and markedly raised digoxin level. What is the most appropriate next step in management?

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Correct answer: C — Give digoxin-specific antibody fragments

The key discriminator is that bradyarrhythmia, ectopy, hyperkalaemia and markedly raised digoxin level, which makes Give digoxin-specific antibody fragments the single best answer. Give controlled oxygen and senior review is less appropriate because it does not address the dominant acute risk in the vignette; Start broad-spectrum intravenous antibiotics would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Arrange urgent CT imaging are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: TOXBASE; BNF digoxin immune Fab